The only meeting point is that we face a common crisis. Available treatments now outstrip our ability (never mind our willingness) to pay for them. In the US this is experienced as a crisis of cost, with health inflation rampant. In the UK it is experienced as a crisis of provision, with the State refusing to finance life-saving procedures.
The fatuous efforts to compare the quality of US care with that of the UK never seem to give sufficient prominence to the money Americans spend purchasing their quality. The World Health Organisation records that in 2006, Americans spent $6,719 per head while Britons spent $2,815. One result of this disparity is the startling fact that the US Government spends more on healthcare per head of population than the UK Government does ($3,076 in the US compared with $2,457 in the UK). The Obama reforms are required as much to get a grip on these costs as to ensure universal healthcare.
Meanwhile, in the UK we have some control over costs (although it doesn’t always feel like that) but little answer to the pressing problem of the next decade ”” how do we decide how much of our income to spend on treatment and how do we cope with the fact that, while every person has a different answer to this question, we all still feel that everyone should get a good standard of care.
You don’t always get what you pay for. It may be that the British health care system is a total disaster. It may be that the British hate it. (My Brit friends say otherwise.) No doubt it is not without its problems. But consider this:
Life expectancy for the U.S. is 78.11; for Britain it is 79.1. In Canada, which is also often cited as a poster child for the evils of government run health care it is 81.23. The U.S. ranks 35th among U.N. member nations. Many industrialized countries with government run health care rank better than the U.S. (See
[url=http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy]World life expectancy tables[/url].) Yes, I know there are problems with life expectancy as a measure of health care. But it is one clue.
In Great Britain the infant mortality rate is 4.80 per 1,000 (22nd), in Canada it is 4.82 (23rd) and in the U.S. 6.3 (33rd). I know there are problems with infant mortality as a measure of health care. But it is another clue.
In Canada the under-five mortality rate (deaths/1,000 live births) is 5.9, in Great Britain 6.0 and in the U.S. 6.3. Are we beginning to see a disturbing pattern here?
Many industrialized countries with government run health care rank better than the U.S. in terms of infant mortality. For the source for the last two statistics, see [url=http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate]World infant mortality tables[/url].
And yet we spend more than twice as much per capita on health care than Great Britain. (See [url=http://ucatlas.ucsc.edu/spend.php]Health care spending[/url].)
You don’t always get what you pay for. And there is evidence that government operated single payer health care may actually provide better health care at a lower cost than the American approach.
So, if I get your drift, we’re supposed to take three statistics that you rightly admit are problematic in gauging the quality of their respective nations’ health care systems and…use them to gauge their respective nations’ health care systems?
Where in life expectancy and U5MR stats do we find the people hobbled by conditions left untreated as policy? Where are those blinded, paralyzed, left in pain, made to wait in agony for a CAT scan?
Maybe they don’t exist? So these governments with single-payer systems are cleverly treating JUST those patients that will give them the highly-coveted “long life, low infant mortality, low mortality before age 5” stats meanwhile letting everybody else go blind??
Horsehockey. “We have the greatest health care system in the world and everybody else’s health care stinks” is like a religious mantra for many in the U.S. Here’s an idea – ask people who’ve lived BOTH in the U.S. AND in some other industrialized country whose health care system they prefer.
I lived in Canada for five years when I was a graduate student. I was issued a health care card when I showed up. ALL my health care in those five years was free. I had two operations on my jaw that some in the U.S. might consider to be cosmetic (problems with occlusion.) A lot of my friends were married and had kids there. The city we lived in had a TOP maternity hospital. Nobody was waiting in line for anything!
Here, I’m self-employed and I pay $24k per year to cover my family (because we need drug benefits and there is only one policy available to individuals in NJ that covers more than 50% of your prescription drugs.) Would I go back to the Canadian system? In a heartbeat. Will we ever have a system like that in the U.S.? Never.
PS Please note that neither I nor most of my friends were Canadian citizens!! The Canadian government’s policy is basically “if you live here, we don’t want you gong without health care because ultimately that’s going to cost us money.”
Jeffersonian,
You’re not seriously suggesting that there aren’t disparities of care among American populations or between regions? You don’t even have to make it a class issue; here in Pittsburgh simple proximity to numerous top-of the-line facilities makes western Pennsylvania health care so much more comprehensive for the general population than in, say, Appalachia.
The NHS has always tended to prioritize acute over chronic care; that’s a reality that has become much more of a problem as life expectancy has increased (though older populations are also generally healthier than they were sixty years ago).
Argue against single-payer, by all means, but don’t reduce Anglo-Canadian health care to the sort of one-liner you just used.
The disturbing pattern that [i]I[/i] see is a failure to understand [url=http://en.wikipedia.org/wiki/Covariance]covariance[/url] in statistics. Regarding the numbers themselves, a more interesting question is, given that under-five mortality subsumes infant mortality, why does the gap close as children grow older?
I think most people who’ve been following this debate understand by now that the variation in infant mortality rates is driven by things not captured in the numbers themselves, things like what counts as a live birth in different countries. As far as obstetric or neonatal care goes, US healthcare is excellent.
[blockquote]Maybe they don’t exist?[/blockquote]
They exist, and I witnessed it first hand with a Canuck friend of mine who would have been permanently paralyzed if he hadn’t been able to get a CAT scan in Detroit in just a few days as opposed to the three months-plus he was quoted in Ontario. As I asked before, where does that show up in U5MR or average mortality stats?
[blockquote]Argue against single-payer, by all means, but don’t reduce Anglo-Canadian health care to the sort of one-liner you just used. [/blockquote]
I don’t see the difference, substantively, between what I wrote and your penultimate paragraph. If some remote, unelected and inescapable body of bureaucrats are prioritizing someone else’s acute care over my chronic condition (to, say, boost internation U5MR or life expectancy stats for political purposes), isn’t that forcing me to live in pain?
Jeffersonian,
Your premise is that government bureaucrats are doing the prioritizing; for most of the history of the NHS, doctors did the prioritizing.
Ever since the US-style market reforms were introduced in the early 1990s, the number of bureaucrats has increased as has their say over doctors’ decisions. And they’re using the same criteria that bureaucrats in insurance companies use over here. If the end result is the same, why does it even matter who employs them?
My son had to have a MRI of his pituitary. That ALSO (right here in NJ) took almost 3 months to schedule (being considered non-emergeny) PLUS a special application to and approval by the insurance company. What was your friends problem? I’m going to assume the Canadians didn’t think it was an emergency and it turned out it was. Trust me — that can happen right here (for example, if it turned out my son had actually had a tumor on the pituitary that was life threatening — they didn’t think he did and he didn’t, but they could have been wrong.)
I lived in Canada. I still have tons of friends there. Actually almost all of my friends there are Americans who were at school the same time as me and stayed there because of the outstanding quality of life.
People with life-threatening conditions are NOT waiting for three months for CAT scans!
Thank you Catholic Mom and Jeremy Bonner.
There are, of course, always anecdotal horror stories and good news stories. I can cite cases where people in the U.S. have quite literally died in the waiting rooms of hospitals while waiting to be seen by a doctor. I can cite cases of friends of mine who have experienced medical care in both the U.S. and foreign countries–including Canada, Great Britain, Spain, Germany and Cyprus. I have high school class mates who have gone to Indonesia for medical care.
I’m sorry, that I confused Jeffersonian and Don R with the best facts on the ground. They show that the U.S. pays substantially more per capita than most industrialized countries of the world and the data suggest that they receive less.
And Don R, I know about covariance. I hold a graduate degree and have done doctoral work in educational psychology which involve a good deal of advanced statistics, including the analysis of covariance and its interpretation.
Now, it may well be that there is no causal relationship between how nations provide health care and the outcome in terms of life expectancy and infant mortality. Actually, the analysis of covariance isn’t capable of doing such an analysis; there are other statistical means to scratch the surface of such a question, but you haven’t provided any such analysis or even begun.
From Nat Hentoff (not exactly a “conservative” voice) here:
Ken, I doubt your facts have confused anyone, but I am sorry if I insulted you. I my intention was not to provide an analysis to fill in the gaps in the available statistics, but merely to point out the error of using infant and under-5 mortality as if they were independently confirming of your conclusions, however tentative those might be. I think that a careful review of the data does not support the claim that the US has general problem with lower quality health care than other countries.
Nevertheless, there is certainly a health care [i]cost[/i] problem, which is related to the health insurance cost problem, but somewhat independent of the health care access or provision problem. I think the plans currently being discussed conflate all of those things, and are consequently more likely than not to produce something even worse than we have today.
#9 wrote:
[blockquote]Your premise is that government bureaucrats are doing the prioritizing; for most of the history of the NHS, doctors did the prioritizing.
Ever since the US-style market reforms were introduced in the early 1990s, the number of bureaucrats has increased as has their say over doctors’ decisions. And they’re using the same criteria that bureaucrats in insurance companies use over here. If the end result is the same, why does it even matter who employs them? [/blockquote]
A. I don’t believe for a second that to be the case. If individual doctors are prioritizing there will be a fairly wide diversity in how cases are triaged. If, all of a sudden, doctors all begin prioritizing acute care and ignoring or under-treating those with chronic conditions, something has happened at a higher level. That level is the one paying, i.e. the State.
B. The difference is exits. Private insurance is full of them. If you don’t like your insurer, find another. Where does one go if one doesn’t like one’s single payer’s policies?
#12 Branford
I am very surprised by Hentoff’s story, for that is what it sounds. We take TB incredibly seriously having previously pretty much erradicated it. In the 19thC it was reckoned that 25% of deaths could be put down to TB or consumption as it used to be called.
Here is a copy of the UK government’s guidance:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_075621
Unfortunately there has been a return of the disease here from increased immigration and foreign travel. I would be amazed if a case was not given priority and treated. As far as I know treatment, usually by a combination of antibiotics is not hugely expensive. If however treatment is not followed by the patient and resistance to medicines develops it can be much more expensive.
I am not convinced I am afraid, and if TB were not being treated here I expect I would have heard. It would be a major scandal.
[blockquote]What was your friends problem? I’m going to assume the Canadians didn’t think it was an emergency and it turned out it was. [/blockquote]
He had a pinched nerve in his neck that, over the period of about a month, went from a tingling in his fingertips to almost complete immobilization of the right side of his body and face. He looked like he had Bell’s Palsy on his entire right side. The radiologist of the private clinic that read the scan said he had less than a month before the nerve was severed and he was irreversibly paralyzed.
The thing is, he had to raise hell even to get a CAT scan scheduled out three months. His doctor told him it was all in his head. True, such a misdiagnosis is possible here, but here my buddy had an alternative. In Canada, he was stuck. And doctors here weren’t restricted by admonishments to keep costs to “the system” down.
[blockquote]People with life-threatening conditions are NOT waiting for three months for CAT scans! [/blockquote]
Possibly true, but my friend’s condition wasn’t “life-threatening.” He just would have been paralyzed for life.
Here is the advice given to patients:
http://www.immunisation.nhs.uk/publications/283234_tuberculosis_2p.pdf
I remember the fuss when someone returning from Iran [days of the Shah] was diagnosed with TB at school. We were all screened thoroughly – you have never seen such a kerfuffle with people in white coats all over the place.
The bottom line is this by almost any measure healthcare in the US is superior, not just for those with health insurance, but for everyone. A few more random thoughts: Sweden, Canada, GB and others are trying to introduce market reforms; why do we want to proceed down a path that those countries have already proven are unsustaninable? What is magic about 16% spending on healthcare? It is a good, just like entertainment; why should we be concerned if overall spending on healthcare goes to 30% of GDP, provided it is from private expenditures and not government?
Three reforms would take care of most of the “problem:”
1. Tort reform
2. Portability (i.e. decoupling health insurance from employment and transfer the tax deductibility to individuals)
3. Elimination of coverage mandates; i.e. enforce Article 4.
Give me an everyone else all the funds my employer expends for me included in my paycheck and then tax me a flat rate (say 15% on insurance $) for a plan to provide insurance vouchers to the indigent.
If the decision is not mine the result is serfdom.
For the purpose of argumentation here’s some info on cancer survivability and detection.
[blockquote]Overall Cancer Survival Rates. According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology : 1
• American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women. [See Figure I.]
• American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.
• Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.
• For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.
These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average: British men have a five-year survival rate of only 45 percent; women, only 53 percent.
Survival Rates for Specific Cancers. U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology , confirming the results of previous studies. As Figure II shows:
• Of cancers that affect primarily men, the survival rate among Americans for bladder cancer is 15 percentage points higher than the European average; for prostate cancer, it is 28 percentage points higher. 2
• Of cancers that affect women only, the survival rate among Americans for uterine cancer is about 5 percentage points higher than the European average; for breast cancer, it is 14 percentage points higher.
• The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular).
Furthermore, the Lancet Oncology study found that lung cancer patients in the United States have the best chance of surviving five years — about 16 percent — whereas patients in Great Britain have only an 8 percent chance, which is lower than the European average of 11 percent.
Results for Canada. Canada’s system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 data by June O’Neill, former director of the Congressional Budget Office, and economist David O’Neill, found that overall cancer survival rates are higher in the United States than in Canada: 3
• For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
• For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.
Early Diagnosis. It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government. 4
• In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.
• The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.
Access to Treatments and Drugs. Early diagnosis is important, but survival also depends on getting effective treatment quickly. However, long waits for treatment are “common devices used to restrict access to care in countries with universal health insurance,†according to a report in Health Affairs . 5 The British National Health Service has set a target for reducing waits to no more than 18 weeks between the time their general practitioner refers them to a specialist and they actually begin treatment. A study by the Royal College of Radiologists showed that such long waits are typical, and 13 percent of patients who need radiation never get it due to shortages of equipment and staff. 6
Another reason for the higher cancer survival rates in the United States is that Americans can get new, effective drugs long before they are available in most other countries. A report in the Annals of Oncology by two Swedish scientists found: 7
• Cancer patients have the most access to 67 new drugs in France, the United States, Switzerland and Austria.
• Erlotinib, a new lung cancer therapy, was 10 times more likely to be prescribed for a patient in the United States than in Europe.
One of the report’s authors, Nils Wilking, from the Karolinska Institute in Stockholm, explained that nearly half the improvement in survival rates in the United States in the 1990s was due to “the introduction of new oncology drugs,†and he urged other countries to make new drugs available faster.
Conclusion. International comparisons establish that the most important factors in cancer survival are early diagnosis, time to treatment and access to the most effective drugs. Some uninsured cancer patients in the United States encounter problems with timely treatment and access, but a far larger proportion of cancer patients in Europe face these troubles. No country on the globe does as good a job overall as the United States. Thus, the U.S. government should focus on ensuring that all cancer patients receive timely care, rather than radically overhauling the current system.
________________________________________
1. Arduino Verdecchia et al., “Recent cancer survival in Europe : a 2000–02 period analysis of EUROCARE-4 data,” Lancet Oncology, 2007, No. 8, pages 784–796.
2. The U.S. bladder cancer data is from “Cancer Facts & Figures 2007,” American Cancer Society. Available at http://www.cancer.org/downloads/STT/CAFF2007PWSecured.pdf.
3. June O’Neill and Dave M. O’Neill, “Health Status, Health Care and Inequality: Canada vs. the U.S.,” National Bureau of Economic Research, NBER Working Paper 13429, September 2007. Available at http://www.nber.org/papers/w13429.
4. K. Davis et al., “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care,” Commonwealth Fund, May 2007. Available at http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678.
5. Sharon Willcox et al., “Measuring And Reducing Waiting Times: A Cross-National Comparison Of Strategies,”
Health Affairs , Vol. 26, No. 4, July/August 2007, pages 1,078-1,087.
6. M.V. Williams et al., “Radiotherapy Dose Fractionation, Access and Waiting Times in the Countries of the UK in 2005,” Royal College of Radiologists, Clinical Oncology , Volume 19, Issue 5, June 2007, pages 273-286.
7. Bengt Jönsson and Nils Wilking, “A Global Comparison Regarding Patient Access to Cancer Drugs,” Annals of Oncology , Vol. 18, Supplement 3, June 2007. [/blockquote]
And your data are? Significantly you provide absolutely no data whatsoever to review.
Yes, I am aware of the difficulties in the analysis of actual data such as I cite. I am aware that life expectancy in Japan (82.12–one of the highest in the world) is influenced by diet which is low in red meats, high in fish and vegetables. One can come up with counter examples. For example, metropolitan France (80.89) has significant problems with smoking and alcoholism which should depress the statistic. It may be that other countries have a longer life expectancy because there is significantly less reliance on the automobile. My childhood buddy who has lived in Germany for years left me breathless walking around Reutlingen last summer–but then, he doesn’t even own an automobile.
But so far, the data that are cited in opposition to any sort of rational health care system in the U.S. are anecdotal, to which contradicting anecdotal evidence can be cited, both of which are largely meaningless when one is talking about populations in the millions–whether in the U.S., Canada and Great Britain.
The fact of the matter is that there are “gate keepers” in any system of medical care, whether it be a government bureaucrat (in Canada or Great Britain) or a corporate bureaucrat (in the U.S.). And there are horror stories of denied medical care in Canada, Great Britain and the U.S. And the data actually suggest the possibility that the cost/benefit ratio in the U.S. isn’t what it should be.
I think the mischaracterisation of healthcare in Great Britain is extraordinary. It is far from perfect but the strange stories coming out of Hentoff and to some extent Daniel Hannan just are not credible. Britain is both the originator and a leading provider of healthcare with kings and presidents coming here for treatment. We also train people from all over the world. It is one of the anomolies of our system of medical provision that the consultant who sees the foreign dignitary in a private hospital is also likely to see someone with a similar problem in the nearby NHS hospital.
Many professionals flit between the two systems running both a private and a public practice. Patients do the same. I have seen my NHS GP [who also has a private practice] and then on his advice gone to a private hospital for a same day Xray [rather than waiting a week or so for an NHS one] and then gone back to him to decide what to do next.
Not that all is perfect, it is inefficiently managed and could be better, usually in delivery rather than quality, but it is far from the benighted system being portrayed.
[blockquote]If you don’t like your insurer, find another. Where does one go if one doesn’t like one’s single payer’s policies?[/blockquote]
The anecdote given here is that Canadians come to the U.S.–if they can afford it.
One can cite anecdotal evidence that Americans who are blocked from affordable health care by the American “system” go to Puerto Rico, Indonesia, etc. where they can get good, affordable treatment even when they factor in the costs of transportation and living temporarily in the foreign country.
“If you don’t like your insurer, find another.” Would that it were so easy. I, like many other Americans have no choice, Jeffersonian. I work for a university that has a medical center and an insurance company and so that is all we are allowed. And, I am really lucky to have the coverage I do.
And, to your point that “bureaucrats aren’t making decisions”, I currently have chronic pain that I am attempting to avoid having surgery to correct. My orthopedist and pain specialists both heartily recommend acupuncture for this. My insurer even has a “complementary medicine center” that offers it. However, it is not covered and there is no way to appeal it, even though my doctors have told me they would. Because of this I am being forced into having a surgery that will cost my insurer 100 times what acupuncture would.
You can not honestly tell me that this is either sensible or something I have any real choice about. And, again, I realize that I am truly lucky to have what I have!
mtucker, it sounds like you already have what the Democrats would like all of us to have (which is no choices and bureacracy), and it sounds like you don’t like it.
[blockquote]And your data are? Significantly you provide absolutely no data whatsoever to review.[/blockquote]
Is that what this forum is for? I’ll reiterate my point: you cannot draw a sensible conclusion based simply on macro-level data, and the data that you cited are worthless for anything but forming hypotheses or posturing.
[blockquote]You can not honestly tell me that this is either sensible or something I have any real choice about. And, again, I realize that I am truly lucky to have what I have! [/blockquote]
You’re right, I do realize that. Of course, you can purchase supplemental insurance if you so choose, but I understand your point. Far be it from me to defend the current system, rife as it is with state intervention. In fact, the reason you have the plan you do is the legacy of a 65 year-old intervention in the market that is, I’m sorry to say, desperately in need to reform. We simply must decouple health insurance from employment and let people buy their own policies so they can shop prices and compare benefits as they do with any other product.
Amen to that, Jeffersonian (#26)! It would help, too, if we could let go of the notion that it makes sense to “insure” against expenses we know we’re going to incur, essentially hiring someone else to pay our bills for us.
25. Don R wrote:
[blockquote]I’ll reiterate my point: you cannot draw a sensible conclusion based simply on macro-level data, and the data that you cited are worthless for anything but forming hypotheses or posturing.[/blockquote]
And your unsupported rants are even more worthless. I’ll give “gdb in central Texas” credit. At least he provides an argument that is supported by credible evidence. Shouting “[b]YOU’RE WRONG AND I’M RIGHT![/b]” isn’t an rational argument.
26. Jeffersonian wrote:
[blockquote]Of course, you can purchase supplemental insurance if you so choose, but I understand your point. Far be it from me to defend the current system, rife as it is with state intervention. In fact, the reason you have the plan you do is the legacy of a 65 year-old intervention in the market that is, I’m sorry to say, desperately in need to reform. We simply must decouple health insurance from employment and let people buy their own policies so they can shop prices and compare benefits as they do with any other product.[/blockquote]
Of course the problem with this solution is that many people simply cannot “purchase supplemental insurance if you so choose” either because the cost would be so high, in spite of “they can shop prices and compare benefits”, that they could not afford it or because they could not obtain insurance at any price. That is particularly true with anyone with a “pre-existing” or chronic condition.
Certainly the theory of free markets is a rational way to apportion the scarce resource of luxury cars; but allocating health care resources to those who can afford them rather than to those who need them makes no rational sense at all.
There are limits to what laissez-faire economics can do humanely.
Well, you are so right on this. Except that we have to add in two factors: 1) everybody must be required to have insurance and 2) companies can adjust prices based on age, but not on so-called “pre-existing conditions.”
I’m paying 24k a year to get the ONLY individual policy in NJ that covers prescription drugs at more than 50%, whereas all my friends have BETTER insurance that their employers are providing for a fraction of that because the employers are using their collective negotiating power. (Oh yeah, and my friends are getting this massive benefit free of taxation.) My insurance company keeps raising the premiums, because frankly they’d be DELIGHTED for me to give up my insurance because they don’t WANT to be in the “individual” market, but they’re forced by the state to do so if they also want to provide employer coverage in this state.
But if you think there’s screaming from the heavens right now about the relatively minor tinkering Obama wants to do, just let him try proposing that insurance be delinked from employment — he’d be tarred and feathered (not withstanding that it makes the U.S. non-competitive and distorts the labor market when people make decisions about what kinds of jobs they want to do and where they want to do them).
Pre-existing conditions are indeed a problem since as Don R points out correctly in #27, a company is no longer insuring against a risk but contracting to pay the bills it knows it will incur, situation akin to calling up a State Farm agent to buy a policy on a home that is currently on fire. A good reason to buy insurance when it’s still insurance, I’d say.
The last I looked, health care is also a scarce resource since the Good Lord has not seen fit to cause it to fall from Heaven. The purchasing-power-parity price of just about everything in America has been falling for decades, the notable exceptions being two of the most regulated and subsidized facets of American life: education and health care. I’d say there’s a message there.
Before we discuss humanity, perhaps getting defintions in order would be advisable. Is it considered humane where you are to threaten people if they don’t pay your bills for you? We tend to put people in jail here that do such things.
Jeffersonian, I believe you misunderstand me… the determinations made in my case, and many others, have not been made by any governmental authority but instead are the product of the whim of my insurer and I am quite sure they were simply made to protect profits. And this condition I have (a spinal issue) disqualifies me for any supplemental coverage, no matter how much I would be willing to pay for it!
This is why I believe in single payer– if we are all “in the pool together” and there is no profit margin to protect, doctors can decide what is best for their patients and the care is covered, period. And, it turns out to be much cheaper as well for everyone involved.
[blockquote]Well, you are so right on this. Except that we have to add in two factors: 1) everybody must be required to have insurance and 2) companies can adjust prices based on age, but not on so-called “pre-existing conditions.†[/blockquote]
I’m not sure why an insurance company couldn’t adjust premiums on more than just age, and I certainly don’t know why they should be forced to ignore PEC’s. That’s simply a loaded gun pointed at them that requires them to not insure against a possible eventuality, but to just fork over the cash in exchange for a premium that, by definition, doesn’t cover the cost. If they insure you prior to that circumstance, that’s the risk they run. But it’s just plain wrong to expect them to do that after the condition has manifested itself. No one would expect you to turn over your property for less than what you would freely want in exchange for it, I don’t see how we can claim to be moral people and do the same thing to an insurance company just because it happens to be politically popular to do so.
Ken Peck wrote: [blockquote]And your unsupported rants are even more worthless.[/blockquote]
Rants? Good grief! Did you actually read anything I wrote? I’m not talking about data, but about the interpretive framework we bring to the data. Most analytical errors occur, not in the mechanics of the statistics, but in not paying attention to what underlies the numbers and in not carefully examining our own presuppositions.
[blockquote]Shouting “YOU’RE WRONG AND I’M RIGHT!†isn’t an rational argument.[/blockquote]
At least we agree on that.
[blockquote]Jeffersonian, I believe you misunderstand me… the determinations made in my case, and many others, have not been made by any governmental authority but instead are the product of the whim of my insurer and I am quite sure they were simply made to protect profits. And this condition I have (a spinal issue) disqualifies me for any supplemental coverage, no matter how much I would be willing to pay for it! [/blockquote]
I’m assuming that what you’re willing to pay for it is less than the expected cost of treatment. Correct?
If your insurance company is acting whimsically and denying treatment that you (or our company) has paid them to indemnify, I’d be beating a path to my state oversight board and screaming bloody murder. Contracts are a two-way street, and they must uphold their end of the bargain. If your condition isn’t covered, then, well, you’re out of luck.
“Health insurance” is a misnomer for everybody. You are buying “health care” which has an insurance like component in that everybody is pooled together and you pay a premium which is pretty much the average of what everybody is consuming every year (which may be much much more or much much less than you actually consume. )
You do this for three reasons: 1) You are, in fact, insuring yourself against the “much much more” contingency; 2) Buying health care through an insurance company means that, even if you paid every bill out-of-pocket, you’d still be much better off than someone with no insurance, because you’re paying the “secret negotiated” fee (there was an article in the NY Times about this today) and not the fee that people who don’t have the ability to negotiate pay and 3) Most of the time the whole thing is actually part of your compensation which for historical (and now political) reasons you get entirely tax free!
And of course, we do have a huge bloated bureaucracy that makes decisions about our health care — it’s called the insurance companies. Just an interesting article the other day. They’ve made great progress with some cancer chemotherapies and some new drugs for some cancers can now be administered by the patients themselves at home. Except the insurance companies view this as a “pharmacy” rather than a “medical” expense and most of them have caps and co-pays on prescription drugs which make this financial impossible for most patients. So patients are BEGGING their doctors to let them come in and be treated with the old drugs because that way at least they’ll be able to get treatment. The treatment is not as good, it’s far more unpleasant AND the insurance companies pay more for it, but everybody has to wait 5 years or so before the bureaucrats change their minds.
It certainly makes sense to refuse to take people with “PECS” in situations where people have chosen NOT to be insured in the hope that they wouldn’t need insurance, then, when they find out they have a medical problem, pick up insurance. [Of course, as we all know, this is not by any means the only way this happens. Somebody loses their job (the dumb linking of employment and health insurance again) can’t afford insurance for a period of time, then later tries to buy insurance and is refused. Many times when they didn’t even KNOW they had a medical condition!] This is why the requirement that PECs cannot be taken into account has to be linked with the requirement that everybody has to have insurance. The two are inextricably linked together. You have to have insurance whether you’re healthy or sick (good for the insurance company) and the insurance company has to insure you whether you’re healthy or sick (good for the insurance company.) Obviously if everybody were priced on their actual health at any given moment, healthy 25 year olds would pay $300/year and sick old people would pay $100,000. At that point we might as well have no insurance and everybody just pay out of pocket. Remember, this is not like fire insurance — you’re buying a product AND an “insurance” (future risk) component.
Even more reason to not tie health insurance to employment, I’d say. I don’t lose my car insurance when I change jobs, why should I lose my health insurance?
I’d agree with you on PECs that haven’t yet manifested themselves being excluded insofar as it gives the insurer too much wiggle room to weasel out of coverage. I mean, did I have a single prostate cancer cell in my body when I signed on to my current employer six years ago, so if I develop it now I can be denied coverage? As I said, too vague.
[blockquote]Obviously if everybody were priced on their actual health at any given moment, healthy 25 year olds would pay $300/year and sick old people would pay $100,000.[/blockquote]
So? Isn’t true insurance a reflection of risk, and aren’t old and sick people a higher risk?
34. Jeffersonian wrote:
[blockquote]If your condition isn’t covered, then, well, you’re out of luck. [/blockquote]
And so we are back to Marie Antoinette; “Let them eat cake.”
Or is it Thomas Malthus and Ebenezer Scrooge; “Let them die and decrease the surplus population”?
On the other hand someone once wrote,
“We the people…in order…to promote the general Welfare…” or something to that effect. I believe that Thomas Jefferson would not have subscribed to the “you’re out of luck” theory of government.
I must have a couple of pages missing from my Constitution, Ken. Can you show me where the federal government is authorized to set up a national health care system and force everyone into it?
Oh, and Jefferson was an anti-federalist. He had no input into the writing of the Constitution (he was in Paris at the time) and was opposed to the ratification of same.
Catholic Mom, I think you’re right about “health insurance” being a misnomer, but I’ll take issue with your reason 2 in #35. Re the “secret negotiated” fee, most providers will also give a better price for paying cash. The fee reductions that insurance companies get results from agreements that reduce the paperwork burden and delays in payment, whereas private parties impose neither of those on care providers. They essentially offer something at an inflated list price (in their case, to cover a worst-case potential cost), while giving “discounts” or coupons to bring the price down. Services in general don’t scale like manufacturing operations do, so there’s usually not much advantage to “volume” purchases.
Any of us can, in the worst case, fall back on Medicaid (or Medicare if we’re old enough), but the purpose of insurance is to protect assets. If I have no assets, it makes no sense for me (or anyone else) to spend the money on insurance for me. At some time or another, most people are in that position. Eventually, we get enough in assets to make them worth protecting, at which point we should buy insurance. Health insurance is like life insurance in that respect. Who should decide when I have enough assets to warrant buying it?
Catholic Mom, when you say. “But if you think there’s screaming from the heavens right now about the relatively minor tinkering Obama wants to do,” I think you’ve already lost the argument. There is absolutely nothing “minor” about what he’s trying to do. Over and over on this board the folks wanting socialized medicine have themselves had to spend a lot on health care. This is unfortunate, and the insurance and medical industries need to address the problem of the ridiculous costs. Perhaps some type of high risk pool can be established. But the fact remains that some people will have to spend a lot of money on their health problems. Forcing other taxpayers to pay for your bad situation is not following the principles our the country was founded on. If someone has high medical bills, that’s when family, friends and church should help out if they can. And yes, Christians should help out people in need. I just don’t think it’s “Christian” to involve the government.
[This thread is becoming fractious. Would commenters please address the issues and not each other. We do not wish to have to delete comments – Elf]
41. Don R wrote:
[blockquote]Re the “secret negotiated†fee, most providers will also give a better price for paying cash.[/blockquote]
My experience is the exact opposite, although it has always struck me odd that the rates charged by “out of network” physicians and dentists were always higher than the insurance negotiated price, even when I was a cash patient.
The weirdest was the father-son dentists in joint practice. Son was in-network, dad was out-of-network. I made the mistake of going to dad and getting soaked, with my dental insurance reimbursing me for only a fraction with me doing all the paperwork. Then there was the surgeon once who was “in network” on weekends but “out of network” on week days. I made the mistake of having the surgery done on a week day. And again I got soaked. That was also the run around with the insurance company claiming the surgery wasn’t pre-approved, whereas it had been pre approved.
Insurance isn’t always a matter of “protecting assets”. Going out of the health care field, consider the annuity policy (or life insurance converted to an annuity). There everyone is gambling. The insurance company is betting I’ll die before the actuarial tables predict and I’m betting that I’ll outlive the actuarial tables. If I die before, the company wins; if I die after, I win. Life insurance reverses the gamble: If I die before the actuarial table predicts, I win (or rather my heirs); if I die after, the company wins.
In either case, the company wants a large enough pool of low risk policy holders that their wins will out pace their loses. And generally speaking the larger the pool, the lower the risk to the company. Which is one reason why small businesses have trouble insuring their small pool of employees.
Yes, but health “insurance” isn’t “true” insurance.
Car insurance is “true” insurance. You buy a car. Car insurance does not help you with that. You get it maintained, change oil, get tuneups. Car insurance does not help you with that. The car starts to get old and need major repairs. Car insurance does not help you with that. Eventually the car is good for nothing but the junk heap and you (or a subsequent owner) junks it. Car insurance is not buying you a new one.
What car insurance DOES do mainly is protect you from having your house/life savings taken away from you if you kill/maim somebody in an accident that’s your fault. So it protects you from unlimited downside risk of being sued. To a lesser degree it protects you from limited downside risk (limited to the value of your car) of you smashing up your car. (However only the first kind of insurance is legally required — the second kind may or may not make financial sense depending on the value of the car.)
Now imagine this instead. At age 17 everyone is issued a car. You can’t buy another one (ever) you can’t trade it for another one (ever). What you get is what you get, for life. You may get a car that needs huge amounts of maintenance. You may get a car that runs like a dream. However (if you live long enough) the car you were assigned at age 17 will get older and older and almost certainly will need some major repair work as it ages. Undoubtedly a new form of car insurance would then arise — one in which you start paying into at age 17 and continue to pay into your whole life so as to 1) spread the costs associated with running your car out over your whole life and 2) insure against the possibility that you discover at age 20 that you’ve been issued a total clunker that’s going to bankrupt you over the years. Now, the car insurance companies might want to make it so you pay more as the car ages, or you pay more if you get stuck with a clunker, but if they effectively dumped you in those two conditions (by making you pay the true cost of the cars care) then there would effectively BE no insurance — just the car insurance company collecting premiums from those with excellent cars that almost never need repairs.
But the fact that some people have serious medical problems and some don’t isn’t the problem. While it’s true that those that advocate for the single-payer system may be have serious health problems (though there are many who more support such a system who DON’T) that’s mainly because they’ve seen how the system we have now doesn’t work, and not just because some get sick and some don’t. If I worked for the UAW I could get as sick as I liked and be set for life. If I were a U.S. Senator my kids could have million dollar a year medical problem and I wouldn’t have a worry in the world. On the other hand, I might work for a company and have health insurance that covered all my needs and then tomorrow I get fired. It’s the complete irrationality and randomness of the system that needs fixing.
This thread is really rather entertaining because a lot of the time proponents are making their case on the basis of a lot of anecdotal evidence. Anecdotes might illustrate, but they cannot be used as the grounds on which to make a case — it is illogical to argue from the specific to the general.
Having experienced healthcare on both sides of the Atlantic I could come up with horrible stories from the US approach to healthcare, and equally horrific ones from the UK system. I could point out a good few of the major shortcomings of both systems, having been a recipient in both and having a daughter who has been an MD in both. I could also point out that while the US system has some major problems that it has to address, so does the UK system (but they are rather different).
The issue comes back to presupposition, and whether we believe healthcare provision is the responsibility of the individual or the community as a whole, and what should be the approach toward those who fall between the cracks — as in the US millions do.
A question I would ask my fellow-Americans is if it is possible in a modern nation that is committed, as the Declaration says, to “life, liberty, and the pursuit of happiness,” whether the exclusion of millions from adequate healthcare enables or disables these things. I make this comment not because I have any desire to make cheap points, but because I think it is important that we begin to analyze what our presuppositions might be.
As a Christian I believe that Scripture is God’s word written. A powerful thread running through Scripture is that of the bringing in of God’s Kingdom, and it is a Kingdom of both justice and peace. Now, the question for Christians is to ask ourselves how we translate these values into the way in which we live within the civic context. We will certainly come to different conclusion about appropriate outcomes, but we need to ask ourselves how God’s nature is reflected in our thinking and decision-making
Sixty years ago Britain made a decision about healthcare based upon a set of assumptions that I personally believe were partially correct but in many respects significantly flawed. The system needs a radical overhaul if it is to meet 21st Century challenges, and it is time to ask my fellow-Brits whether the nation has the courage to question and correct many of those original assumptions.
But is not that the way it always should be in intelligent societies? I would say exactly the same thing about the US system of healthcare as I say about the British. Do we want to dig into our prepared positions and just lob shells at one another, or do we want to solve a very difficult set of concerns?
Richard Kew, I believe you’ve summarized it nicely. Our presuppositions are more determinative of our conclusions than we may be comfortable admitting.
I would guess that everyone participating in this thread would agree that health care and health insurance could and should be improved in the US, but it’s hard (maybe even pointless) to debate the hows and whys before we understand the different principles we bring to bear on the problem. Beyond that, of course, we don’t even agree on the pertinent facts.
All of which is to say, if we’re serious about improving the situation in the US, if we want something that’s fair, as well as being politically and economically sustainable, it’s not going to happen overnight.
It’s not going to happen at all until it happens. Americans have been looking for health care reform for at least 20 years, with just about close to zero result.
My township has been debating how best to deal with a serious traffic issue at a major highway — build an overpass, build an underpass, close off intersecting traffic and shunt it to a by-pass etc. It’s a hot political issue because all of these choices would involve destruction of something that somebody holds dear. I lived here 20 years ago. In 1994 I moved to a neighboring township. In 2005 I moved back. The exact same people were debating the exact same problem and exactly NOTHING had been done in the intervening 11 years. That was four years ago. Nothing has been done since then either. We have had committees, citizens meetings, town halls, paid experts etc. etc. etc. The fact is, nobody wants to do anything that’s going to p*&* off any significant segment of the voters, so nothing is done.
Health care is the same. We don’t need another ten years to study the problem. We need to do SOMETHING (maybe not create a perfect system, but at least stop the arterial bleeding of costs and get more people insured.) If we don’t do it now, when are we going to do it???
I think something will happen as a result of the Obama administration and the House pushing the issue. And I don’t think we need years of study, but I also don’t think the voting public has thought about the issue nearly as much as the people who passionately care about a particular solution. Most Americans have been satisfied with the status quo, which is a big impediment to improvement, irrespective of what you or I might consider improvement to be. Now, the fear of losing what’s good in our current system might actually be sufficient to get people to act. Maybe it will even make things better.
So anecdotes can go either way, but I see the underlying philosophy of a “national health care” plan to be that the citizens of a country become commodities of that country. There is no getting around that the British system rations health care based on utility to the overall society. Whether you believe Nat Hentoff about the TB or not, there is no doubt from what I’ve read there and elsewhere that age and ability play a major factor in whether the government covers you or not. I don’t want to be a commodity to my government, a thing, an expense. And I don’t want a government bureaucrat in charge of my health care. The government can’t even handle the “Cars for Clunkers” program – please!
And this plan (HR3200) which is the only one we’re really talking about now would end up covering federal funding of abortions – see here (Weekly Standard) and here (Associated Press) – no matter what anyone says. Look at the actions and the legislation, not the speeches, to see what’s really being proposed.
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It seems to me that the actual divide is between those who think that everyone should be totally responsible for his own medical care and its cost–either paying cash on the barrel head or by carrying some sort of “insurance” policy where the premiums essentially cover the individual’s costs. And those who think that we each share responsibility for our neighbor’s well being.
If we take the later view from a Christian perspective of the ultimate worth of every human life, it will get described one way perhaps. If we describe it from a secular perspective–which is the only one which will carry much weight in the political areana–it will get described in a utilitarian sort of way.
And involved in the political discussion in the United States we get entangled in the fact that different people read the Constitution differently.
To see something of these issues in an arena other than medical care, consider education. The federal government has been involved in public education almost from the very beginning. In the midwest there are universities (e.g., Western Reserve-Case) which (at least for the “Western Reserve” part of it) resulted from federal land grants in the Western Reserve. There are also local public schools that have their origin in the same legislation. It might be interesting to see how the Congresses in the early 19th century justified these grants constitutionally. (I suspect they cited the commerce clause.)
More recently (i.e., after the Civil War, the Spanish American War, the Mexican War, WWI and WWII and following), more “aggressive” federal involvement in education at all levels. And if you go back and read those acts you will discover they start out citing Congress’ responsibility for the National Defense–i.e., recruits who could read and write made better soldiers than recruits who were illiterate and, indeed, illiteracy significantly reduced the pool of recruits. And more recently, the federal emphasis on science was justified as contributing to national defense: Rockets can be used to put a man on the moon and explore space or to deliver destruction on an enemy.
So, if we leave Christian love of neighbor out of it, we are left with the “dehumanizing” arguments that healthy citizens make more productive workers who pay more in taxes and contribute more to interstate commerce and even better soldiers than sick citizens. And so there is a commercial interest as well as a national defence interest that we all be healthy rather than sick. (And perhaps eat less and better, get exercise, stop smoking, etc.; and live in an evironment where air, water and land are poisoned.)
I suppose the Christian argument is that we should freely pay for our neighbor’s healing. Unfortunately TEC is more interested in suing Christians than in healing the sick. The Good Samaritan did, after all, not only bind up the man’s wounds and carry him to the inn; he also picked up the man’s bill at the inn.
But, quite frankly, due to the fallen nature of all of us, that isn’t going to work in a country of over 300 million people–or in a world of 8 billion. It is easy to say, let everyone pay his own way. But unfortuantely, wealth is not evenly distributed and never will be. Some are able to pay their own way (with millions and even billions left over). Others simply are not able to pay their own way. And to make matters worse, those others–the poor–are very likely to have more serious medical problems than the rich. And I am sorry to say it, but the view of let each pay his own way when it comes to health care is to adopt the economics of Thomas Malthus.
Look at the Constitution as secular scripture. If we don’t read it as it was written, with the same intent, then it becomes a meaningless document whose only purpose is to serve the ends of those who are in power at the moment. TEC is the perfect illustration of this in its willingness to overturn five millenia of Judeo-Christian Bible interpretation. Those who think the Constitution authorizes a system like this are engaging in a similar destruction of the underlying document to get what they want. The denouement of this process will not serve anyone well.
Ken, I actually think pretty much everyone agrees that we have some degree of responsibility for our neighbors, varying with how much responsibility they are capable of assuming for themselves. The biggest disagreement is about whether the government is the proper instrument for discharging those responsibilities. There seems to be an assumption that the government is capable of fulfilling our responsibilities for Christian charity. I’d argue that it isn’t, and, although it might be able to simulate it for a while, it will ultimately work against it.
The Constitution of the United States
Article. I. – The Legislative Branch
Section 8 – Powers of Congress
[blockquote]The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and [b]provide for the common Defence and general Welfare[/b] of the United States[/blockquote]
[blockquote]To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.;[/blockquote]
I would point out a long tradition of a broad interpretation of the Constitution of the United States.
A couple of examples.
Nowhere in the Constitution will you find the power of judicial review (the ability of the courts to declare an act of Congress or of a state unconstitutional) granted to the judiciary. [i]Marbury v. Madison[/i], 5 U.S. (1 Cranch) 137 (1803) established that by judicial fiat.
Nowhere in the Constitution will you find that the federal government has the power to add to its territory by purchase. President Thomas Jefferson doubted that it was constitutional to do so, but he proceeded with the Louisiana Purchase anyway in 1803.
Turned out that 1803 was a very bad year for strict construction of the United States Constitution.
Other “constitutional interpretations” were settled by the Civil War.
One can and perhaps should debate whether to tax people to benefit other people. But we do it all the time. I may not ever avail myself of the parks, recreational centers, libraries, American Airlines Center or zoos–but I am taxed so that others may enjoy them. On the other hand, others are taxed so I can enjoy the Dallas Symphony in the Meyerson Symphony Center and the Dallas Opera in the Winspear Opera House that opens this fall. I was opposed to the Iraqi War, derived no benefit from it, nor did it contribute to the national defence; but I am taxed for it anyway.
As I said, healthy citizens make better soldiers and thus health care contributes to the national defense.
These are not, of course, “Christian arguments” but are, rather limited to our secular Constitution. It is pretty obvious that the churches of the United States are in no position to assume the costs of medical care for the millions of people without medical insurance. Not even the entire extensive assets of TEC would make a dent in that problem.
[blockquote]The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States.[/blockquote]
[i]Some, who have not denied the necessity of the power of taxation, have grounded a very fierce attack against the Constitution, on the language in which it is defined. [b]It has been urged and echoed, that the power to lay and collect taxes, duties, imposts, and excises, to pay the debts, and provide for the common defense and general welfare of the United States, amounts to an unlimited commission to exercise every power which may be alleged to be necessary for the common defense or general welfare. No stronger proof could be given of the distress under which these writers labor for objections, than their stooping to such a misconstruction.[/b]
Had no other enumeration or definition of the powers of the Congress been found in the Constitution, than the general expressions just cited, the authors of the objection might have had some color for it; though it would have been difficult to find a reason for so awkward a form of describing an authority to legislate in all possible cases. A power to destroy the freedom of the press, the trial by jury, or even to regulate the course of descents, or the forms of conveyances, must be very singularly expressed by the terms to raise money for the general welfare.
But what color can the objection have, when a specification of the objects alluded to by these general terms immediately follows, and is not even separated by a longer pause than a semicolon? If the different parts of the same instrument ought to be so expounded, as to give meaning to every part which will bear it, shall one part of the same sentence be excluded altogether from a share in the meaning; and shall the more doubtful and indefinite terms be retained in their full extent, and the clear and precise expressions be denied any signification whatsoever? For what purpose could the enumeration of particular powers be inserted, if these and all others were meant to be included in the preceding general power? Nothing is more natural nor common than first to use a general phrase, and then to explain and qualify it by a recital of particulars. But the idea of an enumeration of particulars which neither explain nor qualify the general meaning, and can have no other effect than to confound and mislead, is an absurdity, which, as we are reduced to the dilemma of charging either on the authors of the objection or on the authors of the Constitution, we must take the liberty of supposing, had not its origin with the latter. [/i]
James Madison, Federalist 41
And Madison ought to know…he wrote the thing. Hamilton echoed this in F84, pointing out that no Bill of Rights was needed insofar as the power to regulate speech, assembly, press, etc. was not found in the Constitution, thus Congress was debarred from doing so. But somehow we’ve lost that and the result is an imperial Congress that is driving our nation into receivership.
Sorry…meant to address this, too:
[blockquote]President Thomas Jefferson doubted that it was constitutional to do so, but he proceeded with the Louisiana Purchase anyway in 1803.[/blockquote]
Which is why he submitted it under the treaty power, entirely proper.
The constitution says:
“We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.”
Health care comes under “promote the general welfare” IMHO. As Kenneth Arrow noted (which undoubtedly Jefferson notes), health care is a peculiar entity.
I’m always wary of originalist arguments. Blacks weren’t quite part of that constitution, and I’m often struck how race still matters.
As far as Christian charity goes: when Christian doctors start offering their services for free and churches return to setting up free clinics, I’ll agree that Christians have overcome their original sin and begun to give what they are required of their God. As Augustine noted, government is a consequence of original sin, not an excuse.
[blockquote]Health care comes under “promote the general welfare†IMHO.[/blockquote]
You might want to read that Madison citation a bit more closely. The general welfare clause confers no power to the federal government, but simply lays out a principle toward which the powers that are conferred should be directed. This is reinforced by the 10th Amendment. But perhaps the Bill of Rights is passe’ too, given that it was written and ratified during a period of slavery in some of the states. BTW, the statement that the Constitution didn’t apply to blacks is historically untrue. Blacks in the free states were certainly covered.
More importantly, the Constitution is law that restrains government, not individuals. In a sense, this bizarre theory of inventing new interpretive methods with time is a way to do away with that law, producing, ultimately, a lawless government. Shades of TGC, writ large, I’d say.
60. Jeffersonian wrote:
[blockquote]You might want to read that Madison citation a bit more closely.[/blockquote]
Of course one should remember that it was Madison (then Secretary of State) and Jefferson that the Supreme Court ruled had acted unconstitutionally in [i]Marbury v. Madison[/i], 5 U.S. (1 Cranch) 137 (1803).
So much for Madison being the definitive voice on how the Constitution is to be construed.
So, because a law is broken it therefore is invalid?